1: 1 Transfusion strategies are right for the wrong reasons

Area of Science:

• Trauma and Injury Research
• Coagulation and Hemostasis
• Critical Care Medicine

Background:

• Early identification of coagulopathies is crucial for managing injured patients.
• Abnormalities include hypercoagulable states and acquired coagulopathies.
• Aggressive plasma use (1:1 resuscitation) is a current approach to address coagulopathy.

Purpose of the Study:

• To characterize coagulopathies in different hemorrhagic profiles among injured patients.
• To describe the relationship between transfusion needs and clot function.
• To identify distinct patient groups based on transfusion patterns.

Main Methods:

• Group-Based Trajectory Modeling used transfusion volume over time to define hemorrhagic phenotypes.
• Included injured patients receiving at least one unit of packed red blood cells (PRBC) within 24 hours.
• Thromboelastography (TEG) profiles were characterized for each subgroup.

Main Results:

• Four hemorrhagic profiles identified in 330 patients: minimal, late large PRBC, massive PRBC, and early PRBC.
• All groups showed shorter R-times, indicating rapid clot initiation.
• Massive PRBC group (Group 3) exhibited longer K-times, flatter alpha-angles, and weaker clot strength, with worse outcomes.

Conclusions:

• Hemorrhagic profiles reveal rapid clot formation but suppressed thrombin and diminished clot strength in severely injured patients.
• Patients exhibit both hypercoagulability and hypocoagulability.
• Goal-directed resuscitation, including early massive transfusion protocols, may be more effective for coagulopathic patients.